Understanding Healthcare Changes for Children: Key Reforms and Transitions

1. Overview and Children’s Advocates’ Response ACA and Other Changes Affecting Children Kristen Golden Testa Director, CA Health Program The Children’s Partnership November 1, 2012 www.childrenspartnership.org

2. Reforms Affecting Children • Exchange coverage • Enrollment system • Insurance reform • State-only programs for kids • Healthy Families transition

3. Exchange Coverage • Exchange offers insurance • New coverage subsidies below 400% FPL • 144,000 estimated children covered • SHOP coverage

4. Exchange Coverage Issues • Essential Health Benefits • Dental • Habilitation services (hearing aids?) • Mental health • Children in multiple coverage families • Child only plans • SHOP connection to other coverage

5. Enrollment System • Streamlining and simplifying • Coordinated among the programs • Challenges: county and state systems • Children in “multiple program” families

6. Insurance Reform • Guaranteed issue protection for children • Limited premium variability for pre-x • Continued coverage for young adults on parents’ coverage • Governor vetoed guarantee issue protection for all (with premium protection for children)

7. State-only Programs • CHDP Gateway • GHPP • FamilyPACT • Breast and cervical cancer • Others?

8. Healthy Families Transition 2012/13 budget eliminated Healthy Families Program (HFP) and transfer all HFP enrollees to Medi-Cal Legislature oversight and a flexible start date, no sooner than January 1, 2013.

9. Transition Basics • All HFP children transfer to Medi-Cal • Children above 150% FPL income charged premiums • Transition in 2013 over phases based on county health plans comparability to HFP • (CCS is in both programs)

10. Phases of the Transition • Phase 1 (DHCS timeline: January and March 2013) • Part A counties (208,376 kids): Alameda, Riverside, San Bernardino, San Francisco , Santa Clara, Orange , San Mateo, San Diego • Part B counties (185,714 kids) : Contra Costa, Fresno, Kern, Kings, Los Angeles, Madera, Tulare, Sacramento, Napa, Solano, Sonoma, Yolo, Monterey, Santa Cruz, Santa Barbara, San Luis Obispo • Phase 2 (261,060 kids; After April 1, 2013) • Phase 3 (152,602 kids; After August 1, 2013) • Phase 4 (42,753 kids; After September 1, 2013)

11. Pro’s and Con’s Pro: • Greater scope of benefits in Medi-Cal • Limited to no copayments Con: • Possible access concerns • Transition might be bumpy • Continuity of care challenges

12. What Families Should Expect General notice 60- and 30-day notices for Phase 1 90-, 60-, and 30-day notices for Phases 2-4 Medi-Cal welcome packet Benefit Identification Card (BIC) Packet from managed care plan (and dental managed care plan, where relevant)

13. Transition Issues: Enrollment • Sufficient notice to families about the transfer • Outreach to “first responders” (counties, CAAs, doctors, teachers, etc) • Transitioning children transferred without gaps or having to provide additional information • Not charged premiums if income < 150% • New applicants should all receive AE

14. Transition Issue: Access • Health plan network adequacy assessment: public review and contingency plans • Direct provider participation survey • Ongoing monitoring • Enforcement of network adequacy and continuity of care

15. Transition Issue: Performance • HFP Transition performance standards: • Did children transfer without gaps • Were they able to continue care • How did their access compare • Baseline comparison to transition

16. Taking Action • To CHHS: • Not ready for January 1, more reasonable timeline • Performance measures needed • Plans for improving access and continuity of care • Local feedback on readiness and needs on the ground • To Legislature: • Ensure transition readiness and children can see their doctor/dentist before transition begins.

17. For More Information TCP’s Website: www.childrenspartnership.org Contact me: Kristen Golden Testa 415-505-1332 ktesta@childrenspartnership.org